I came out to my friends and one of them betrayed me. He told everyone and my locker got stuffed with notes saying, 'Don't spread your HIV! You perv!' My counselors and teachers won't help me, even the principle and vice principals won't help me. Two weeks ago I got a desk thrown at me and now I have a broken arm. I really need your help more than ever before.

That type of plea is all too common on the online peer education forum run by Advocates for Youth, program manager Jesse Gilliam told the National Coalition for LGBT Health at their fall meeting in Washington, D.C., Sept.13.

'It's really important to get a sense of the priorities from the youth perspective,' said Beth Beck, director of health programs at the National Youth Advocacy Coalition. She reviewed findings from the focus group they convened.

In addition to the expected ones of coming out and family, she was surprised to hear the fear of pregnancy. Many of the concerns center around issues of mental health. Beck expressed concern that GLBT youth drop out of school at a higher rate, in part because of these added pressures and few sources of support.

'Unfortunately most of the existing resources are wrapped around HIV/AIDS' prevention activities and are tied to CDC funding. The Bush administration has imposed tighter restrictions on content, but more importantly, the CDC has begun to shift resources from broad community-based prevention to programs targeting those who are already HIV positive.

During the 2000 funding cycle the Centers for Disease Control supported 88 grants that included youth, but when those grants were recompeted and given out this past July, only eight programs serving youth were funded—just two of them serving GLBT youth—Beck said. 'The effect is really being felt across the country.'

Gilliam pointed out that even while proven HIV prevention activities have been essentially flat funded for the last several years, funding for 'abstinence-only until marriage' prevention programs has grown several-fold.

'The impact is obvious, GLBT youth can't get married,' she said. The heterosexual focus of the programs 'makes them feel even more isolated.' One study in Massachusetts found that GLBT youth were more likely to skip AIDS education programs because of this stigma. Robert Winn, MD, on the faculty of family medicine at Jefferson Medical College in Philadelphia, emphasized three things. The first is that 'youth are different than adults, their issues are different.' He urged participants not to lose sight of the fact that '70 percent of LGBT youth do just fine'; the focus should be on understanding better why that is. Finally, reform is needed not just in laws but also in education and within the medical community.

A survey of young GLBT patients about healthcare providers showed that 'kids are smart,' they aren't impressed by posters or rainbow flags, rather, 'It's about the clinician's interaction with them.'

Winn said the problem is that physicians are not trained very well in areas of sexuality and they are very uncomfortable talking about it with their patients. LGBT issues are harder still, and trans issues are completely left out.

David Haltiwanger, director of clinical programs at the Chase Brexton Clinic in Baltimore, drew from his experience as a therapist when he said that the struggle with their sexual orientation has led many GLBT people to drop out of school, 'or choose jobs where they are underemployed because it feels like a safer place to work. And then later in life they regret that.'

'I think of that as a health issue because the primary source of health insurance in America is through your employment. Anything you can do to help youth stay in school is going to have long term implications for their health because it will maximize their access to healthcare as they grow older.'

TRANS COMPLEX

If the issues are great and resources scant for gay and lesbian youth, the situation is even worse for trans youth, said Caeden Dempsey, field director for the National Center for Transgender Equality. 'Very few therapists understand trans issues, especially as they relate to youth,' Dempsey said. There may be pressure to get the youth to conform to traditional gender roles.

Violence and murder prevention are the leading issues for this segment of the community. Trans youth seem to be more likely to face violence in their home and are more likely to end up out on the street. The pattern tends to repeat itself in the relations they later form, either because those are the patterns they have learned, or because 'they are trapped in these situations,' financially and/or emotionally dependent upon their sexual partners and unwilling or unable to seek out help.

Joel Ginsburg, executive director of the Gay and Lesbian Medical Association, said they recently received a grant to address issues of domestic violence within the GLBT community and will be holding a conference on the subject in San Francisco toward the end of the year.

Dempsey said there are 'very few places where young people can find information about their trans bodies and safer sex.' The increased risk of homelessness correlates with an increased risk of involvement in sex work and in substance abuse, both of which increase the risk for acquiring HIV.

Most young people who have health insurance coverage gain it through their parent's policy. That disappears if they are kicked out. And even if they are covered through their parents or their own workplace, the policy seldom covers hormone therapy or surgery.

'The options are to wait until they are older' to make the transition, 'or try to get them in other ways,' Dempsey said. 'Usually those other ways come in finding hormones on the street, which can be done, or finding 'sketchy' doctors that will prescribe something without adequate monitoring'

The question of transiting is complicated by the fact that there is no consensus within the trans community or within the medical community on when is the best time to do so. Some argue that individuals should wait until they are adults, while others point to the biological changes of puberty that are easier to forestall than reverse.

'Transition becomes more difficult and costly after puberty,' said Miriam Yeung, policy director at the LGBT Community Center in NYC. 'You don't have to shave off your Adam's apple' if you don't develop it. Still, many agencies have a policy of not treating minors with hormones toward transition.

There also are legal liability issues concerning minors that chill interventions by psychologists and physicians. One participant spoke of a youth in Colorado who wanted to make a transition and the parents supported the decision. But liability issues forced the family to go outside the state.

Barbara Warren, Yeung's colleague at the Community Center, said they do not have these problems in Europe where the government provides healthcare and the liability issues do not arise. She said, 'The right thing to do sometimes isn't the legally supported thing to do.'

Dempsey urged that the principle goal be 'to give trans youth the tools to make health decisions for themselves.'

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